# An 82-year-old client with an eGFR of 22 mL/min takes a standard adult famotidine dose and develops confusion and a prolonged QT interval. Which action should the nurse take?

> source: MyMerci (mymerci.kr)  
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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

An 82-year-old client with an eGFR of 22 mL/min takes a standard adult famotidine dose and develops confusion and a prolonged QT interval. Which action should the nurse take?

## Option

1. Administer an additional dose because confusion indicates uncontrolled gastric acid secretion.
2. Continue the same regimen and repeat the electrocardiogram at the annual examination.
3. Add a second histamine-2 blocker so famotidine can be cleared more rapidly.
4. Hold the next dose and obtain prompt renal-dose and adverse-effect review. **✔ Correct answer**

**Correct answer: 4**

## Explanation

Famotidine clearance is reduced in moderate or severe renal impairment, increasing the risk of central nervous system reactions and QT prolongation unless the dose is adjusted.

## In-depth explanation

Quick answer
Link renal accumulation to new neurologic and electrical toxicity.

Why this is correct
The new findings require prompt medication review and assessment rather than further exposure or delayed follow-up.

Easy analogy or mental picture
Use a closed medication-safety loop: identify the exposure, connect the new findings, interrupt further harm, support physiology, and verify the response over time.

Memory hook
Exposure, interaction, toxicity pattern, immediate action, serial reassessment.

NCLEX decision rule
Choose the action that reduces the most immediate medication-related risk while preserving monitoring and escalation.

Why the other choices are wrong
Options that continue the exposure, treat only one symptom, or delay reassessment leave the toxic process active.References
1DailyMed: Famotidine TabletsRenal dose reduction and increased risk of central nervous system reactions and QT prolongation

## Clinical scenario

Medication safety review
Verify the indication, route, interacting medicines, current respiratory and gastrointestinal findings, authorized action, and measurable follow-up.

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